Nearing the End of Life

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Choosing hospice care

Hospice care puts you and your loved ones in the care of experts on the end of life. Hospice care focuses on quality of life rather than length of life. The hospice philosophy accepts death as the final stage of life: it affirms life and neither hastens nor postpones death.

Hospice care treats the person rather than the disease, working to manage symptoms so that a person’s last days may be spent with dignity, surrounded by their loved ones. It’s also family-centered – it includes the patient and the family in making decisions.

You, your family, and your doctor decide together when hospice care should begin. If home hospice care is chosen, a caregiver must be in the home with the patient 24 hours a day.

To learn much more about this option, please see our document called Hospice Care, or call us for a free copy.

What makes me eligible for hospice care?

Even though a person must be expected to have 6 months or less to live to enter hospice, other standards are also used to decide if a person with cancer is eligible for hospice. In most cases, you must have widespread, aggressive, or progressive disease as seen by increasing symptoms, worsening lab values, and/or evidence of the spread of cancer cells to distant parts of your body. You must also be unable to work or do certain things for yourself. Finally, you must have either refused life-prolonging therapy or have been getting worse in spite of treatment. You, your family, and your doctor decide together when hospice care should begin. Home hospice care is covered by most health plans, Medicare, and even Medicaid in some states. (See the section, “Who pays for hospice care?”)

What does hospice care provide?

Hospice care is used when your disease can’t be cured, and you are expected to live about 6 months or less if the illness runs its usual course. Hospice gives you supportive or palliative care, which is treatment to help relieve symptoms, but doesn’t cure the disease. Its main purpose is to improve your quality of life so that you can be as alert and pain-free as possible. Here are some of the services you can get through hospice:

  • Pain and symptom control
  • Home care and/or inpatient care (if needed)
  • Spiritual care that’s designed for your needs
  • Regular family conferences
  • Coordinated care − the team of people involved in your care work together to meet your and your family’s needs
  • Respite care, to allow friends and family some time away from caregiving
  • Bereavement care for surviving loved ones to help them through the grieving process

How do I find hospice care?

Since most communities have more than one hospice provider, you and your family will need to decide which agency you’ll use for hospice services. Finding the hospice program that best meets your needs may take some research, but it will be time well spent.

You and your family should do this early in your care while you have the strength and ability to take part in the decision. Quality of care, availability of needed services, the types of services covered, staff training and expertise, and insurance coverage all need to be considered. Here are some things to think about as you start your search:

Local resources

Your doctor or hospital discharge planner can help you find hospices in your area. Hospice care providers also are listed in the phone book. Your community may have information and referral services available through your local American Cancer Society, an Agency on Aging, a local United Way chapter, or the Visiting Nurse Association.

State resources

You may contact your state’s hospice organization or its department of health or social services to get a list of licensed agencies. The state health department oversees certification of hospice services. Certification makes a hospice able to get funding from Medicare and, in some states, Medicaid. Check the blue pages of your phone book for other resources in your area or search online for your state hospice organization.

National resources

National organizations that deal with hospice care accreditation, treatment, and patient advocacy are listed in the “To learn more” section at the end of this document. Some of them can also tell you which hospices are near you.

Who pays for hospice care?

Home hospice care usually costs less than care in hospitals, nursing homes, or other institutional settings. This is because less high-cost technology is used and family and friends provide most of the care at home.

Medicare, Medicaid in most states, the Department of Veterans Affairs, most private insurance plans, HMOs, and other managed care organizations may pay for hospice care. Along with this, community contributions, memorial donations, and foundation gifts allow many hospices to give free services to patients who can’t afford payment. Some programs charge patients according to their ability to pay.

Medicare

To get payment from Medicare, the agency must be approved by Medicare to provide hospice services. The patient must be seen by their own doctor and the hospice medical director (a doctor) to be certified for the first 180 days of hospice care. After the first 180 days, the patient must be seen again to be re-certified every 60 days for as long as the patient is getting hospice care.

If you’re not sure how hospice might work for you, Medicare offers a one-time only hospice consultation. You can meet with a hospice medical director or hospice doctor to discuss your care options and treatment needs. You don’t have to choose hospice care if you use this consultation service.

Medicaid

In 1986, laws were passed to allow states to develop coverage for hospice programs. Most states have a Medicaid hospice benefit, which is patterned after the Medicare hospice benefit. See more information on Medicaid in the section “Health Care Coverage.”

Private insurance

Most private insurance companies include hospice care as a benefit. Be sure to ask about your insurance coverage, not only for hospice, but also for home care.

Private pay

If insurance coverage is not available or it doesn’t cover all the costs, the patient and family can hire hospice providers and pay for services out of pocket. Some hospices are able to provide services without charge if a patient has limited or no financial resources.


Last Medical Review: 01/14/2014
Last Revised: 02/06/2014